The first questions asked in a dental office is always do you have insurance coverage? Many people assume there are different prices for those with insurance and those without insurance coverage. Although every office will follow the own protocols. The fact remains. The same price should be used for everyone with or without insurance coverage.
It’s crucial for each individual with an insurance plan to know what exactly their insurance coverage provides them and ensure what treatment they are being provided as well as what their insurance company is being charged for the visit to the dental office.
Just like many professionals our fees are based on time spent completing a service.
Preventative oral health services:
Examples:
| 3 months | 6 months | 9 months | 12 months | |
| New Patient exam (every 3 years) | NA | NA | NA | NA |
| Dental Hygiene Exam | ||||
| X-rays (as needed) | ||||
| Canary Scan (as needed) | ||||
| Scaling 6 units (1.5 hours) 8 units (2 hours) 10 units (2.5 hours) 12 units (3 hours) 14 units (3.5 hours) 16 units (4 hours) unlimited | BEST option 22.5 minutes 30 minutes 37.5 minutes 45 minutes 52.5 minutes 60 minutes --------------- | 45 minutes 60 minutes 75 minutes 1.5 hours 1.75 hours 2 hours --------------- | 67.5 minutes 1.5 hours 112.5 minutes 135 minutes 157.5 minutes 180 minutes --------------- | 1.5 hours 2 hours 2.5 hours 3 hours 3.5 hours 4 hours --------------- |
| Root planning (as needed) | Same as above | Same as above | Same as above | Same as above |
| Tooth polish (as needed) | ||||
| Fluoride applications (as needed) | ||||
| Desensitizing (as needed) |
Insurance companies also have the option to add percentage, current fee guide, calender year/rolling year or a maximum allowance.
Percentages: can be 80%, 90%, 100%, etc.
Example: Bob’s insurance company pays 80% of his services. Bob is responsible for paying the remaining 20% not covered by his insurance plan.
Current Fee Guide: Each year a new fee guide is set out by our professional association. If an insurance policy is using a 2013 fee guide and the current year is 2016. There may be a small balance owing after services have been completed.
Example: Bob had the following services completed; 3 unit scaling (45 minutes): $150. 2013 fee guide pays $145. Bob is responsible for paying the $5 insurance didn’t pay from the 3 year lag in current fees.
Calender/rolling year: Calender year refers to the January-December allowance of insurance. You have until Dec 31 of the current year to use your insurance. As of January 1st your coverage allowance begins again. Rolling year refers to the last time your service was completed. This doesn’t go by a January-December term. It’s based on your last service date.
Maximum Allowance: you may have a maximum allowance per year or term. If you go over this amount, you would be responsible for paying any remaining amount.
Example: Bob’s insurance plan allows for a maximum of $1500 per year. He requires $2000 worth of treatment in this period. Bob is then responsible for paying the remaining $500.
Note: This table is designed to give an idea of how preventative oral health coverage can work. It is in no way a means of treatment for every dental office. All treatment and recommendations would be based on individual needs. Your registered dental hygienist will design a treatment for you, which may be more or less than your insurance allows. This table reflects what some insurance companies provide. It’s important to note that individual businesses choose what services will be provided by the insurance companies.
